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FOR I NSTRUCTI ONS, SEE BACK OF FORM

DI SCLOSURE SUMMARYPAGECOMMI TTEENAME ( Mu s t b e s ame a s o n St a t eme n t o f Or g a n i z a t i o n )

X - q. r jJ q Fe r 5 e NGt ( fI MPORTANT: I n d i c a t eb y# t y p e o fc o mmi t t e ey o ua r er e p o r t i n gf o r: =( 1) S t a t e w i d e / L e g i s l a t i v e / J u d g eS t a n d i n gf o rR e t e n t i o nCa n d i d a t e(2 ) S t a t ePAC ( 3 ) S t a t eP a r t y( 4 ) C o u n t yC e n t r a lC ommi t t e e( 5 ) C o u n t yCa n d i d a t e(6 ) C i t yC an d i d a t e(7 ) S c h o o lB o a r do rO t h e rP o l i t i c a lS u b d i v i s i o nCa nd i d a t e( 8 ) C o u n t yPAC ( 9 ) C i t yPAC ( 1 0 ) S c h o o lB o a r do rO t h e rP o l i t i c a lS u b d i v i s i o nPAC( 1 1 )L o c a lB a l l o tI s s u e

CANDI DATECOMMI TTE ESONLY :Ca n d i d a t eName

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L a t er e p o r t sa r es u b j e c tt op o s s i b l ec i v i la n dc r i m i n a lp e n a l t i e s. P u r s u a n tt o I o waC o d es e c t i o n6 8 B. 3 2 A ( 7 )t h ec a n d i d a t e ,f o ra c a nd i d a t e ' sc o mmi t t ea n dt h ec h a i r p e r s o n ,f o ra n yo t h e rt y p eo fc o mmi t t e e ,i st h ei n d i v i d u a lr e s p on s i b l ef o rf i l i n gt i m e l ya n da c c u r a t er e p o r t s.

IAM F I L I N GA J Z ; 1 Z Nr( r e p o r td a t e ) I n d i c a t eb y# FL I

E] CHECKI FAMENDMENT TO REPORT DATED

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REPORT FOR ( 1 )ELECTI ONI ( 2 ) NON- ELECTI ONYEAR.

STATEMENTOF

CASH ON HAND

CASHON HAND a t t h e b e g i n n i n go ft h er e p o r t i n gp e r i o d. ( T o t a lo f a l lf u n d sh e l db y t h ec o m m i t t e e. T h i samount MUST b e t h es ame a s t h ec a s h o nh a n d a t t h ee n do ft h el a s tr e p o r t i n gp e r i o do rmus tb e z e r oi ft h i si sf i r s tr e p o r tf i l e d. ) . . . . . . . .. . . . . . . .. . . . . . . . .. . . . .. . . . . . . . . . .$ADD TOTALMONEY TAKEN I NTHI SPERI OD

S c h e d u l eA: Cas h C o n t r i b u t i o n st o t a l( A t t a c hS c h e d u l eA ) ( * a l s os e e i n - k i n db e l o w). . .. . . . , . . . . . . . . . .S c h e d u l eF: L o a n sR e c e i v e dt o t a l( A t t a c hS c h e d u l eF ) .. . . . . . . . . . . . . . .. . .. . . , . . . . . . . . . . . . . . .. . . . .. .. . . . . . .. . , . , . . .. ,S c h e d u l eH: To t a lSa l e so fCampa i gn P r o p e r t y( A t t a c hS c h e d u l eH ). . . . . . . . . . . . . . . .. . . . . . . . . .. . . . . . . . . . . . . .

CASHON HANDa t t h ee n d o f t h i sr e p o r t i n gp e r i o d( i ff i n a lr e p o r tb a l a n c em u s tb e z e r o ) ( A t t a c hDR- 3 ). .. . . .. . .. . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . .. . .. . . . . . . . . . . . . . . . .. . . . . .. . .. . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . .. . . . .. . . .$

' " ' UNPAI DBI LLS ( Fr o mSc h e d u l eD- At t ac hS c h e d u l eD ). . . . . . . . . . . . . . . . . . . . . . . . . .. . , . . .. . . . . . . . . . . . .. . .. . . . . . .. . . . .. . . .. _ _ $* I NKI NDCONTRI BUTI ONS( F r o mS c h e d u l eE - A t t a c hS c h e d u l eE ) . . . . . . . .. . .. . . . . . . . . . . . . .. .. . .. . . . .. .. ,. .. ,. , . . . .. . . . .. $

STATE COMMI TTEES: S u b mi ta r e c on c i l e dc amp a i g na c c ou n t b a n k s t a t e me n ti nJ a n u a r yo fe a c hy e a r.

FORM

( R e v. 1 2 1 2 0 0 5 )

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A u d i t e d

DI SCLOSUREREPORT

L o c a lC ommi t t e e s ,e n t e rD a t eo fE l e c t i o n

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YES V NO

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CANDI DATECOMMI TTEESONLY :

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( Sc h e du l eH a p p l i e st oC a n d i d a t e s 'Commi t t ee s On l y )

SUB- TOTAL.. .. . .. .. .. . $ - 14 1SUBTRACT TOTALMONEY SPENT THI S PERI ODS c h e d u l eB: E x p e n d i t u r e s

t o t a l( A t t a c hS c h e d u l eB ) ( * " a l s os e e d e b t sa n dl o a n sb e l o w). . .. . . . . . . . 0 1 0 2S c h e d u l eF: L o a nRepay men t s t o t a l( A t t a c hS c h e d u l eF ).. . . . . . . . . . . . . . . . . . .. . .. . . . . . . . . . . . . . . . . . .. . . . . . .. . .. . . . . . .

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T HI SBOXA PP L I E STOCAND I DATES 'COMMI TTEE SONLY:

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Ex p e nd i t u r e st o p e r s o n s / e n t i t i e sp r o v i d i n gc o n s u l t i n g ,a d v e r t i s i n g ,f u n d - r a i s i n g ,p o l l i n g ,ma n a g i n g ,o r g a n i z i n g s e r v i c e smu s ta l s ob ed e t a i li t e m i z e do nS c he d u l eG b yt h ea mo u n t ,p u r p o s e ,a n dd a t eo fe a c ht y p e o fe x p e n d i t u r emadeb yt h ep e r s o n / e n t i t yo nb e ha l fo ft h ec a n d i d a t e ' sc o mmi t t e e. ( R e f e rt oS c he d u l eG i n s t r u c t i o n sa n dI o w aCode6 8A. 4 0 2 ( 3 ) ( i ). )

Page_ - _

( f o rS c he d u l eB )

FOR I NSTRUCTI ONS ,SEE BACKOF FORM Re s e tF or m SCHEDULE

EXPENDI TURES B MONETARY- - MONEY SPENT FROM COMMI TT EEACCOUNT ( R e v. 0 7 / 0 3 ) EXPENDI TURESTATEPACCOMMI TT EES: NOTE: FORCONTRI BUTI ONSMADE TOSTATEWI DEORL E GI S L AT I V ECANDI DATES,L I S TTHECANDI DATEI DE NT I F I C AT I ONNUMBERI NTHEDESI GNATEDCOLUMNANDTHE CHECK THI SBOX I FPACCHECKNUMBER FOREACH EXPENDI TURE. AL I S TOFI DNUMBERSI SAVAI L A B L EFROMTHEI OWA AMENDI NG FORME T HI C S8 CAMPAI GNDI SCLOSUREBOARD.

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THI SBOX APPLI ESTO CANDI DATES'COMMI TTEES ONLY :

P u r c h a s e so f c e r t a i nc amp a i g np r o p e r t yc o s t i n g$ 5 0 0o r mo r emus ta l s ob e i n v e n t o r i e do nS ch e d u l eH. ( R ef e r t oSc h e d u l eH i n s t r u c t i o n s. )

E x pe n d i t u r e st o p er s on s / e n t i t i e s p r o v i d i n gc o n s u l t i n g ,a d v e r t i s i n g ,f u n d - r a i s i n g ,p o l l i n g ,ma n a g i n g ,o r g a n i z i n gs e r v i c e smus ta l s ob e d e t a i li t e m i z e do nSc h e d u l eG b y t h ea mo u n t ,p u r p o s e ,a n d d a t eo fe a c ht y p eo fe x pe n d i t u r emade b yt h e p er s on / e n t i t yo n b e ha l fo ft h e c an d i d a t e ' sc o mmi t t e e. ( R e f e rt oSc h e d u l eG i n s t r u c t i o n sa n d I o w aCode 6 8A. 4 0 2 ( 3 ) ( i ). )

( f o rS c he d u l eB )

FOR I NSTRUCTI ONS,SEE BACKOF FORM Rcc; t l u n n SCHEDULE

EXPENDI TURES B- -MONEY SPENT FROM COMMI TTEEACCOUNT MONETARY( Re v. 0 7 / 0 3 ) EXPENDI TURESSTATEPAC COMMI TT EES: NOTE: FOR CONTRI BUTI ONSMADE TOSTATEWI DEOR LEGI SLAT I VECANDI DATES,L I S TTHECANDI DATEI DE NT I F I CATI ONNUMBERI NTHEDESI GNATEDCOLUMN ANDTHE D CHECK THI SBOX I FPACCHECKNUMBERFOREACHEXPENDI TURE. A L I S TOF I DNUMBERSI SAVAI LABLEFROMTHE I OWA AMENDI NG FORMETHI CS8 CAMPAI GNDI SCLOSUREBOARD.COMMI TTEE

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FOR I NSTRUCTI ONS,SEE BACK OF FORM

COMMI TT EE NAME ( Mu s t b esame a s o n St a t e me nt o fO r g a n i z a t i o n )

SCHEDULE

E I NKI ND( Re v . 0 6 / 9 7 )

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c o mmi t t e e. Re l a t i o n s h i pmu s t b e s h own t o t h et h i r dd e g r e eo f c o n s a n gu i n i t y( b l o o dr e l a t i v e s )a n d a f f i n i t y( r e l a t i v e s ( f o rS c he d u l eE )

b ym a r r i a g e ). ( S e eP a g e 2 o f f o r msp a c k e t. ) I fs u r n ame o f c o n t r i b u t o ri s t h esame a s c a n d i d a t e ,b u tt h e r ei s n of a m i l i a lr e l a t i o n s h i p ,e n t e r" n o ta p p l i c a b l e "i nt h er e l a t i o n s h i pc o l umn.

DATERECEI VED( MMI DDI YR)

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